Frequent attenders in the emergency department: A trainee perspective

Abstract Background Emergency department (ED) attendances are contributing to rising costs of the National Health Service (NHS) in England. Critically assessing the impact of new services to reduce emergency department use can be difficult as new services may create additional access points, unlocking latent demand. The study evaluated an Acute Visiting Scheme (AVS) in a primary care context. We asked if AVS reduces overall ED demand and whether or not it changed utilisation patterns for frequent attenders. Method The study used a pre post single cohort design. The impact of AVS on all-cause ED attendances was hypothesised as a substitution effect, where AVS duty doctor visits would replace emergency department visits. Primary outcome was frequency of ED attendances. End points were reduction of frequency of service use and increase of intervals between attendances by frequent attenders. Results ED attendances for AVS users rose by 47.6%. If AVS use was included, there was a more than fourfold increase of total service utilisation, amounting to 438.3%. It shows that AVS unlocked significant latent demand. However, there was some reduction in the frequency of ED attendances for some patients and an increase in time intervals between ED attendances for others. Conclusion The study demonstrates that careful analysis of patient utilisation can detect a differential impact of AVS on the use of ED. As the new service created additional access points for patients and hence introduces an element of choice, the new service is likely to unlock latent demand. This study illustrates that AVS may be most useful if targeted at specific patient groups who are most likely to benefit from the new service.

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The impact of frequent attenders on a UK emergency department

European Journal of Emergency Medicine ◽

10.1097/mej.0b013e328335623d ◽

2010 ◽

Vol 17 (6) ◽

pp. 332-336 ◽

Cited By ~ 19

Author(s):

Alexandra Dent ◽

Glenys Hunter ◽

Andrew Philip Webster

Keyword(s):

Emergency Department ◽

Frequent Attenders ◽

The Impact

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Frequent attendance: a Clinical and Epidemiological Study

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1610 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S442-S443

Author(s):

S. López-Romeo ◽

G. Ledesma-Iparraguirre

Keyword(s):

Health Care ◽

Emergency Department ◽

Retrospective Study ◽

Emergency Services ◽

Care Facility ◽

Health Care Facility ◽

Frequent Attenders ◽

Frequent Attendance ◽

Competing Interest ◽

New Strategies

BackgroundFrequent attenders (F a) are patients who attend a health care facility repeatedly. The frequency of frequent attendance at emergencies department has been defined as 4 or more attendances/annum. F a are few in number but they produce a high number of attendances.aimsTo determine prevalence of F a, mean attendances/year generated by F a and frequency of visits by months.Methodsa retrospective study was performed on psychiatry's emergency department database from January until December 2013. F a was defined as those with ≥ 4 attendances at emergency services in a year.Prevalence of F a, attendances’ prevalence, diagnosis’ prevalence, Mean attendances generated by F a and frequency of visits by months were analysed.Resultsamong 4824 attendances we found 181 F as (5.98%). Men represented 50.80% and women 49.20%. F a presented a mean of 6.33 attendances/year, while non-F a presented a mean of 1.29 attendances/year.in accordance with frequency of visits by months, it was observed that number of attendances was increased in april and May, in both F a and non-F a.ConclusionPrevalence of F a was 5.98%, F a generated a 23.74% of attendances. Most prevalent F a’ diagnoses were: anxiety disorder, personality disorder non-specified and schizophrenia.F a at emergency department contributes to overcrowd them. for this reason, it is important to take into account these results to develop new strategies to improve F a’ attention and prevent its occurrence.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Profiling frequent attenders at an inner city emergency department

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-019-01964-2 ◽

2019 ◽

Vol 188 (3) ◽

pp. 1013-1019 ◽

Cited By ~ 2

Author(s):

Susan Uí Bhroin ◽

James Kinahan ◽

Adrian Murphy

Keyword(s):

Emergency Department ◽

Inner City ◽

Frequent Attenders

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An audit of frequent attenders at North Manchester General Hospital paediatric emergency department

European Journal of Public Health ◽

10.1093/eurpub/ckw174.194 ◽

2016 ◽

Vol 26 (suppl_1) ◽

Author(s):

M Dobrzynska ◽

J Handley ◽

R Isba

Keyword(s):

Emergency Department ◽

General Hospital ◽

Paediatric Emergency Department ◽

Paediatric Emergency ◽

Frequent Attenders

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Predictors of frequent attenders of emergency department at an acute general hospital in Singapore

Emergency Medicine Journal ◽

10.1136/emj.2009.079160 ◽

2010 ◽

Vol 27 (11) ◽

pp. 843-848 ◽

Cited By ~ 27

Author(s):

P. Paul ◽

B. H. Heng ◽

E. Seow ◽

J. Molina ◽

S. Y. Tay

Keyword(s):

Emergency Department ◽

General Hospital ◽

Frequent Attenders

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2.5 years on: what are the effects of a ‘frequent attenders’ service in the Emergency Department?

BJPsych Bulletin ◽

10.1192/bjb.2019.8 ◽

2019 ◽

Vol 43 (3) ◽

pp. 112-116

Author(s):

Soraia Sousa ◽

Tracey Hilder ◽

Christopher Burdess ◽

Philippa Bolton

Keyword(s):

Emergency Department ◽

Conflict Of Interest ◽

Frequent Attenders ◽

Number Of Patients ◽

Two Samples ◽

The Individual

This study focused on an evaluation over 2.5 years to establish if a frequent attenders' service in an Emergency Department (ED) impacted on the overall number of patients attending as well as the numbers of their attendances. For this, three patient lists from April-September 2015 and three lists from a matched period in 2017 were randomly selected and the two samples compared. Results showed both a reduction in the number of total patients identified as frequent attenders as well as a reduction on the number of attendances to ED. The study suggests that the implementation of a frequent attenders' service is associated with benefits, not only for the individual attendances per patient, but also in an overall reduction of the number patients classed as frequent attenders.Declaration of interestThe authors have no conflict of interest to declare regarding this manuscript.

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The effect of multidisciplinary case management on selected outcomes for frequent attenders at an emergency department

The Medical Journal of Australia ◽

10.5694/j.1326-5377.2006.tb00412.x ◽

2006 ◽

Vol 184 (12) ◽

pp. 602-606 ◽

Cited By ~ 54

Author(s):

Georgina Ann Phillips ◽

David S Brophy ◽

Tracey J Weiland ◽

Antony J Chenhall ◽

Andrew W Dent

Keyword(s):

Emergency Department ◽

Case Management ◽

Frequent Attenders

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The effect of integrated care on self-management and emergency department attendance

BJPsych Bulletin ◽

10.1192/bjb.2019.1 ◽

2019 ◽

Vol 43 (3) ◽

pp. 117-122

Author(s):

Nikki Scheiner ◽

Sarah Cohen ◽

Ruth Davis ◽

Tim Gale ◽

Amanda Agyare

Keyword(s):

Mental Health ◽

Emergency Department ◽

Rapid Assessment ◽

Integrated Approach ◽

Physical And Mental Health ◽

Effect Change ◽

Care Plans ◽

Frequent Attenders ◽

Accident And Emergency ◽

The Impact

Aims and methodThe Frequent Attenders Programme is a joint initiative between Hertfordshire Rapid Assessment, Interface and Discharge service and the Emergency Department of the West Hertfordshire NHS Trust, which aims to divert frequent attenders from the emergency department by addressing their unmet needs. This paper describes the range of interventions put in place from the time that the service was set up in 2014 until the introduction of the new national Commissioning for Quality and Innovation 2017–2019, which tasked National Health Service trusts to improve services for people with mental health needs who present to Accident and Emergency. The terms emergency department and Accident and Emergency are used interchangeably, reflecting the practice in policy documents. A subsequent article will report on the impact of the Commissioning for Quality and Innovation in Hertfordshire.ResultsAnalysis of the interventions indicated a highly significant (P < 0.0001) mean reduction in attendances. Lower gains were made in patients whose primary presentations were alcohol-related. A failure to effect change in two patients led to a significant revision of their respective care plans, resulting in a subsequent reduction in their attendances.Clinical implicationsAn integrated approach to patients with complex presentations was associated with high levels of both patient and referrer satisfaction. It is hypothesised that dismantling the barriers between physical and mental health may lead to similar successes in frequent attenders in other in-patient and community medical and psychiatric services.Declaration of interestNone.

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